DESCRIPTION (Applicant's abstract): This is a request for a Mentored Clinical Scientist Development Award (MCSDA) (KO8). The overall aim of the proposal is to provide the candidate, C. Bruce Baker, MD JD, with a supervised research and educational experience that will enable him to become an independent investigator in mental health services research with a primary emphasis on treatment guidelines. Dr. Baker will be a junior faculty member at Yale University beginning July, 1998. A KO8 award would permit him the time freed from clinical duties and the :tools for successful career development. The research environment at Yale is very fertile for Dr. Baker's needs. His mentors for the MCSDA, Robert A. Rosenheck, MD, William H. Sledge, MD, and Scott W. Woods, MD, are active mental health services researchers with records of successful mentorship of clinical scientists. The Phase One study for a planned progression of studies on treatment guidelines in major depression are described. The overall aim of the series of projects is to determine whether the effectiveness of treatment for major depression is improved when clinicians follow practice guidelines and, if it is, how to promote incorporation of guideline principles into clinical practice. The aims of the Phase One Study are to determine. before any formal introduction of depression treatment guidelines, the degree to which the clinicians of four different mental health agencies follow major principles from the Agency for Health Care Policy Research guidelines for the treatment of major depression, to determine whether degree of adherence correlates with specific clinical and cost outcomes, and to determine whether there are characteristics of the agencies, the clinicians and/or their patients that correlate with a tendency to follow or not follow specific guidelines. The aims of the career development plan include developing facility with research design: becoming proficient in advanced statistics including multivariate analysis, random-effects regression models, and cluster design analysis; becoming more proficient in advanced health care economics, cost-effectiveness analysis and decision analysis; and developing a foundation in information topics and techniques such as guideline analysis tools, and decision support methods such as expert critiquing systems.